{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   W COWAN","gend":0,"add":"900 PANTIGO LN APT 106","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1982-11-27","age":"","mstatus":"","insh":"900035853*01","cliId":"4VG5XA0FK72","pno":"407\/625-7184","cno":"407\/625-7184","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M62.81","G80.0","R97.20","R39.12","Z00.00","M72.2","M79.672","M25.572","M75.52","M25.512","J30.1","N31.9","M54.2","M62.838","R25.2","G80.9","Z97.8","J32.9","M47.816","R07.9","R53.81","I10.","G62.9","F41.9","G47.33","E66.9","R53.83","Z13.220","Z13.1","K55.1","K21.9","R11.2","R22.42","H66.90","M67.02","R51.","F41.1","F32.9","J45.909","J34.2","G93.89","Z90.49","Z79.1","Z79.899","Z79.891","Z79.51","Z82.49","R00.2","R03.0","J30.2","Z99.3","R25.9","J01.90","Z11.59","J34.89","J30.9","G47.30","Z23.","M54.12","S91.301A","R00.0","T85.695A","K21.00","K59.03","T40.605A","Z20.822","Z83.3","Z80.42","Z99.89","R53.1","Z74.09","Z78.9","R68.89","R11.0","F79.","G47.00","M25.469","R60.0","L03.031","L60.0","Z13.89","Z01.810","Z01.812","M50.11","M47.22","M48.02","G95.29","S43.432A","M75.82","R26.9","H53.8","M50.122","S46.012A","M79.602","Z88.9","G24.3","R91.8","K59.00","R12.","K30.","R40.0","H61.22","M25.472","M25.40","M79.89","S90.32XA","G60.9","G89.29","R06.83","D64.9","K35.30","R10.9","D72.829","A04.72","K35.80","K65.1","R69.","K35.32","Z45.1","K35.33","J96.01","K56.7","I96.","J69.0","J81.1","J90.","K65.9","F43.20","M25.50","E78.00","K35.20","Z46.82","R10.10","J18.9","K56.609","K91.89","Z96.89","R10.817","R10.84","Z03.89","Z68.37","R29.818","G80.2","T85.610A","R52.","M79.606","G89.11","K35.891","R09.81","E86.0","A04.71","J44.9","M25.551","T14.90XA","M79.604","M79.605","E87.6","L85.3","M25.561","G80.1","I95.9","G89.4","Z68.32","Z45.2","M79.2","Z74.01","Z74.3","M54.5","G82.50","A41.9","G11.4","R50.9","L89.899","G96.00","M62.82","R50.81","G80.8","T85.610D","R65.10","R53.2","M17.12","R19.7","E55.9","K76.89","N28.89","K57.30","K76.0","R51.9","Z68.36","J11.1","T85.738A","T85.615A","K27.9","Z53.09","T85.690A","M25.562","M79.609","M70.61","F43.23"],"date":["2021-09-21","2021-11-09","2020-10-14","2020-10-14","2019-10-31","2020-07-21","2020-07-21","2020-07-21","2020-10-29","2021-10-05","2021-02-18","2020-10-14","2020-12-31","2021-10-18","2021-11-09","2021-11-19","2021-11-19","2021-01-29","2021-03-08","2021-07-11","2021-04-06","2021-11-19","2021-09-28","2021-11-19","2021-10-05","2021-09-29","2020-10-05","2021-11-19","2021-11-19","2021-03-21","2021-10-05","2021-09-08","2021-04-12","2019-08-01","2020-05-11","2020-08-10","2021-10-19","2021-11-19","2021-05-18","2020-08-08","2020-08-08","2021-10-05","2021-06-27","2021-09-29","2020-08-08","2020-08-08","2021-10-05","2020-08-08","2020-08-08","2021-06-25","2021-10-05","2020-11-03","2020-03-17","2020-03-17","2020-04-06","2020-04-13","2020-11-04","2020-10-05","2021-11-03","2021-01-25","2021-06-27","2021-07-07","2021-03-17","2021-03-17","2021-03-17","2021-09-06","2021-10-05","2021-03-17","2021-06-29","2021-06-27","2021-10-04","2021-10-04","2021-03-22","2021-06-27","2021-03-23","2021-10-05","2021-04-12","2019-11-18","2020-11-18","2020-11-18","2021-11-19","2021-03-11","2021-03-11","2020-10-22","2020-11-02","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2021-10-10","2020-08-08","2020-10-22","2020-10-22","2020-11-02","2019-10-09","2020-12-16","2021-09-06","2021-03-24","2021-03-22","2021-04-02","2019-08-21","2019-08-21","2019-11-18","2019-11-18","2021-06-27","2019-11-20","2019-11-20","2021-07-16","2021-02-11","2021-06-23","2021-05-18","2021-07-15","2021-05-21","2021-06-25","2021-05-09","2021-05-09","2021-04-07","2021-06-01","2021-03-17","2021-05-13","2021-09-21","2021-06-29","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-24","2021-04-19","2021-04-10","2021-04-10","2021-05-03","2021-05-10","2021-05-06","2021-05-16","2021-05-16","2021-09-21","2021-05-03","2021-05-02","2021-05-02","2021-05-06","2021-09-06","2021-05-11","2021-09-01","2021-09-29","2021-09-28","2021-06-28","2021-06-28","2021-06-25","2021-06-16","2021-06-27","2021-05-20","2021-09-21","2021-06-27","2021-06-27","2021-07-16","2021-06-27","2021-09-21","2021-06-21","2021-06-27","2021-10-05","2021-06-29","2021-06-29","2021-06-29","2021-07-05","2021-07-17","2021-07-15","2021-09-21","2021-09-06","2021-09-21","2021-09-21","2021-09-28","2021-09-21","2021-09-23","2021-10-03","2021-09-21","2021-09-21","2021-09-07","2021-10-19","2021-09-15","2021-09-29","2021-11-03","2021-11-19","2021-11-19","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2021-09-29","2021-09-29","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2021-09-29","2021-10-07","2021-10-13","2021-10-05","2021-10-05"],"priorHcc":[null,null,"","","","","","","",null,"","","",null,null,null,null,"","","","",null,null,null,null,null,"",null,null,"",null,null,"","","","",null,null,"","","",null,"",null,"","",null,"","","",null,"","","","","","","",null,"","","","","","",null,null,"","","",null,null,"","","",null,"","","","",null,"","","","","","","","",null,"","","","","","",null,"","","","","","","","","","",null,"","","","","","","","","",null,"","",null,"","","","","","","","","","","","","","",null,"","","","",null,"",null,null,null,"","","","","","",null,"","",null,"",null,"","",null,"","","","","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180030360","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","832105410","BACLOFEN","TAB 10MG","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","47335061930","DRIZALMA","CAP 60MG DR","-30","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","90","Select","Select",""],["","378632377","VALSART\/HCTZ","TAB 160-25MG","30","Select","Select",""],["","93742698","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","93005805","TRAMADOL HCL","TAB 50MG","14","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","-90","Select","Select",""],["","23114501","BOTOX","INJ 100UNIT","4","Select","Select",""],["","60505095303","AZEL\/FLUTIC","SPR 137-50","-23","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","12","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","43598075201","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","378064110","PREDNISONE","TAB 10MG","21","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","270","Select","Select",""],["","11523715802","CORICIDIN","CAP CONG\/CGH","60","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","10","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","-48","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","172392670","DIAZEPAM","TAB 5MG","60","Select","Select",""],["","93226301","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","527193206","CLARITHROMYC","TAB 500MG","42","Select","Select",""],["","59779043280","NASAL DECONG","TAB 30MG","96","Select","Select",""],["","378172193","AMLOD\/VALSAR","TAB 5-160MG","90","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","43598075201","BUPROPION HYDROCHLORIDE ER (SR) ","","60","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","","60","Select","Select",""],["","45802091987","CETIRIZINE HYDROCHLORIDE","","90","Select","Select",""],["","65862050320","AMOXICILLIN\/CLAVULANATE POTASSIUM ","","14","Select","Select",""],["","69097015907","MELOXICAM ","","30","Select","Select",""],["","54327099","FLUTICASONE PROPIONATE","","48","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","","90","Select","Select",""],["","60505095303","AZELASTINE HYDROCHLORIDE\/FLUTICASONE PROPIONATE","","23","Select","Select",""],["","59779043280","CVS NASAL DECONGESTANT","","96","Select","Select",""],["","93742698","MONTELUKAST SODIUM ","","90","Select","Select",""],["","68462010630","ONDANSETRON HYDROCHLORIDE ","","12","Select","Select",""],["","527193206","CLARITHROMYCIN","","42","Select","Select",""],["","68180030360","CEFUROXIME AXETIL","","20","Select","Select",""],["","23155000810","HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","16729020001","BUSPIRONE HYDROCHLORIDE","","180","Select","Select",""],["","11523715802","CORICIDIN HBP CHEST CONGESTION & COUGH","","60","Select","Select",""],["","51991074790","DULOXETINE HCL","","60","Select","Select",""],["","51991081403","AZELASTINE HYDROCHLORIDE","","30","Select","Select",""],["","378172193","AMLODIPINE BESYLATE\/VALSARTAN","","-90","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE","","90","Select","Select",""],["","59746000103","METHYLPREDNISOLONE DOSE PACK","","21","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE","","10","Select","Select",""],["","406012305","HYDROCODONE\/ACETAMINOPHEN ","","60","Select","Select",""],["","378632377","VALSARTAN\/HYDROCHLOROTHIAZIDE","","30","Select","Select",""],["","47335061930","DRIZALMA SPRINKLE","","30","Select","Select",""],["","43598075201","BUPROPION HYDROCHLORIDE ER (SR)","","-60","Select","Select",""],["","00093742698","MONTELUKAST SODIUM","","90","Select","Select",""],["","65862050320","AMOXICILLIN\/CLAVULANATE POTASSIUM","","14","Select","Select",""],["","65862018830","ONDANSETRON HYDROCHLORIDE","","-12","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN","","60","Select","Select",""],["","61442012110","FAMOTIDINE","20MG","60","Select","Select",""],["","45802086803","POLYETHYLENE GLYCOL 3350","3350 NF","510","Select","Select",""],["","43386031208","GAVILAX","","238","Select","Select",""],["","00904672559","SENNA","8.6MG","60","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","53746010901","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","5-325MG","12","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00904677361","ACETAMINOPHEN","325MG","120","Select","Select",""],["","43598075201","BUPROPION HYDROCHLORIDE ER (SR)                                       ","TAB 150MG SR","180","Select","Select",""],["","69097081312","GABAPENTIN                                                            ","CAP 100MG","60","Select","Select",""],["","65862018830","ONDANSETRON HYDROCHLORIDE                                             ","TAB 8MG","12","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","48","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","90","Select","Select",""],["","65862050320","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","TAB 875-125","14","Select","Select",""],["","00093005805","TRAMADOL HCL                                                          ","TAB 50MG","30","Select","Select",""],["","59779043280","CVS NASAL DECONGESTANT                                                ","TAB 30MG","96","Select","Select",""],["","60505095303","AZELASTINE HYDROCHLORIDE\/FLUTICASONE PROPIONATE                       ","SPR 137-50","23","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","00378064110","PREDNISONE                                                            ","TAB 10MG","20","Select","Select",""],["","00093742698","MONTELUKAST SODIUM                                                    ","TAB 10MG","90","Select","Select",""],["","00023114501","BOTOX                                                                 ","INJ 100UNIT","4","Select","Select",""],["","23155000810","HYDROCHLOROTHIAZIDE                                                   ","TAB 25MG","10","Select","Select",""],["","16729020001","BUSPIRONE HYDROCHLORIDE                                               ","TAB 5MG","60","Select","Select",""],["","11523715802","CORICIDIN HBP CHEST CONGESTION & COUGH                                ","CAP CONG\/CGH","60","Select","Select",""],["","51991081403","AZELASTINE HYDROCHLORIDE                                              ","SPR 0.001","30","Select","Select",""],["","00527193206","CLARITHROMYCIN                                                        ","TAB 500MG","42","Select","Select",""],["","00378172193","AMLODIPINE BESYLATE\/VALSARTAN                                         ","TAB 5-160MG","90","Select","Select",""],["","51991074790","DULOXETINE HCL                                                        ","CAP 30MG","60","Select","Select",""],["","68180071160","CEFDINIR                                                              ","CAP 300MG","20","Select","Select",""],["","00172392670","DIAZEPAM                                                              ","TAB 5MG","60","Select","Select",""],["","59746000103","METHYLPREDNISOLONE DOSE PACK                                          ","TAB 4MG","21","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE                                              ","CAP 60MG","90","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE                                               ","CAP 100MG","10","Select","Select",""],["","68180030360","CEFUROXIME AXETIL                                                     ","TAB 500MG","20","Select","Select",""],["","00832105410","BACLOFEN                                                              ","TAB 10MG","-90","Select","Select",""],["","68180012202","CEPHALEXIN                                                            ","CAP 500MG","20","Select","Select",""],["","00406012305","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","60","Select","Select",""],["","47335061930","DRIZALMA SPRINKLE                                                     ","CAP 60MG DR","30","Select","Select",""],["","43386031208","GAVILAX                                                               ","POW ","238","Select","Select",""],["","00904672559","SENNA                                                                 ","TAB 8.6MG","60","Select","Select",""],["","69547035302","NARCAN                                                                ","SPR ","2","Select","Select",""],["","61442012110","FAMOTIDINE                                                            ","TAB 20MG","-60","Select","Select",""],["","45802086803","POLYETHYLENE GLYCOL 3350                                              ","POW 3350 NF","510","Select","Select",""],["","19903001028","MYLANTA MAXIMUM STRENGTH                                              ","SUS MAX ST","355","Select","Select",""],["","60505014601","OMEPRAZOLE                                                            ","CAP 40MG","30","Select","Select",""],["","68462015713","ONDANSETRON ODT                                                       ","TAB 4MG ODT","30","Select","Select",""],["","33342007610","VALSARTAN\/HYDROCHLOROTHIAZIDE                                         ","TAB 160-25MG","30","Select","Select",""],["","42806040001","METHYLPREDNISOLONE                                                    ","TAB 4MG","-3","Select","Select",""],["","57896086406","MELATONIN                                                             ","TAB 3MG","30","Select","Select",""],["","00143312601","DICYCLOMINE HYDROCHLORIDE                                             ","CAP 10MG","90","Select","Select",""],["","55111017915","TIZANIDINE HCL                                                        ","TAB 2MG","150","Select","Select",""],["","00603188016","LIDOCAINE                                                             ","PAD 0.05","30","Select","Select",""],["","42806016005","HYDROXYZINE HYDROCHLORIDE                                             ","TAB 25MG","90","Select","Select",""],["","80681005000","DAILY-VITE MULTIVITAMIN                                               ","TAB ","90","Select","Select",""],["","45802065078","LORATADINE                                                            ","TAB 10MG","30","Select","Select",""],["","00536124810","STIMULANT LAXATIVE                                                    ","TAB 8.6-50MG","30","Select","Select",""],["","20555002200","HIGH POTENCY MULTIVITAMIN                                             ","TAB MULTIVIT","30","Select","Select",""],["","53746010901","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","12","Select","Select",""],["","00904677361","ACETAMINOPHEN                                                         ","TAB 325MG","120","Select","Select",""],["","76282066339","DICLOFENAC SODIUM                                                     ","GEL 0.01","100","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}